New Treatment of Facial Paralysis by Microsurgery with NTL (Technical Viterbo)
 

Facial paralysis is a disfiguring disorder with important implications for psychological, emotional and family, leading these patients to the brink of suicide, because these patients are marginalized within their families, work and social environment. This condition is characterized a complex combination of axonal degeneration and muscle.

Today with advances in technology, the best results are achieved in combination with MICCROCIRUGÍA by facial nerve graft (Cross Face Graft Nerv with NTL) achieving a harmonious and symmetrical smile. Note that the microsurgical treatment of this pathology previously performed in the United States, France, Brazil, Taiwan, Japan and available today in Ecuador (BRASILUET).

History:

This condition was discovered by Charles Bell in 1821, being called Bell syndrome. Currently, according to studies by Murakami, Ko JY, Sheen TS, Hsu MM and other authors, I conclude that the causal agent of this pathology is the herpes simplex virus and Herpes Zoster in 75% of the cases studied in 1996 -2000, other causes are for facial nerve tumors and / or parotid gland, congenital (moebius syndrome), trauma, infections proximity (otitis media with effusion), fractures of the skull base and others. It has an incidence of 10-30 cases per 100 000 inhabitants, is more common in women aged 10-20 years and men over 40 years.
The clinical picture has a sudden onset and progressive during the first 14 days, characterized by pain in front and / or behind the ear, decreased sensation in the middle of the face, inability to close eyelids, oral commissure fall. 10% of cases are bilateral, 60-80% of cases have a full recovery and 7% is recurrent.

Clinical Treatment:

The use of corticosteroids to reduce edema of the facial nerve.

Retrovirals to reduce viral loads-zoster herpes simplex. Eye drops and eye ointments to keep the eye lubricated, preventing the formation of ulcers in the cornea and the most severe loss of the eye.

The electro-physiotherapy to keep the facial muscle trophism.
 

Surgical Treatment:

It is addressed to those who have no improvement or spontaneous regression of facial movements during the first 3 months, and in those with permanent sequelae of facial paralysis several years of evolution. It should be noted that the technique of Viterbo, for its efficiency, is considered among the best 3 results of facial paralysis in the world.

In our experience, we recommend starting the microsurgical treatment from 4 months, is in order to prevent progressive facial muscle atrophy.

The technique of correction of facial palsy treatment is to perform static and dynamic treatment in the same surgery. For the static treatment removes a tissue called the lateral thigh as fascia lata, to reposition the oral commissure in its normal place. The dynamic treatment involves removing the sural nerve in the back of the leg that is about 35-40cm in length, this nerve is used in the face, as in the nerve graft using microsurgical techniques microsurgical microscope or magnifying glass to make a sutured to the buccal branch of facial nerve healthy (termino-lateral neurorrhaphy Viterbo) and the other end of the nerve is inserted into the temporal muscle, which results in a direct mioneurotización able to obtain a spontaneous and symmetric smile.

 

 

Anatomical distribution of the facial nerve

 

 

The facial nerve is divided into 5 sectors:
1 .- Front Bouquet: muscle movement function of the forehead.
2 .- zygomatic Bouquet: function movement of the malar region and occlusion of the eyelids.
3 .- Oral Bouquet: feature allows you smile
4.-Mandibular Branch: Allows depress the lower lip.
5 .- Cervical Bouquet: function works with some of the movements of the neck.

 

 

ESSENTIAL FOR THIS MICROSURGERY Intrumental